Tuesday, March 21, 2017

Treating the anti-doctor violence epidemic in India

The epidemic of violence which has erupted against doctors all over the country has taken everyone by surprise. In the past, doctors used to be respected and trusted . Today, it seems to be open house on doctors , and anytime a patient suffers a complication, goons are taking the law in their hands and mercilessly thrashing the junior doctors who are on duty .

Doctors are running scared. They don't trust their patients anymore , and are on their guard. They're wary , and are no longer willing to treat critically ill patients - exactly the kind of patients who desperately need urgent medical attention. They would much rather transfer them somewhere else in self -defence, because they're scared that if something goes wrong, they will have to put up with both verbal and physical abuse from angry relatives. They don't want to take this chance anymore, because they've become the whipping boys for no fault of theirs. Doctor's whatsapp groups and social media channels are full of anguished messages from angry and upset doctors, who feel they are being targeted for no fault of theirs.

If a patient is critically ill, there's a very high probability that patient will die, no matter what the doctor does. Why do relatives vent their ire on the poor junior doctor who happens to be on duty ? Most young doctors are doing their best, inspite of the pathetic working conditions they are forced to put up with in government hospitals. There is a shortage of medical staff and they are forced to work overtime , no matter how sleep deprived they are ; the infrastructure is creaking; there is inadequate supervision by senior professors, who are not available during emergencies ; and the equipment is either old , missing or malfunctioning. Doctors feel very helpless and vulnerable , because no one in the government is willing to do anything to protect them. Although there is a law which is supposed to protect them, it is never implemented in real life, and this governmental inaction is just making a bad situation worse. The situation has come to a boil, and lots of doctors have started treating patients as potential adversaries . Trust between doctors and patients is breaking down, and patients are going to get hurt when this happens.

Government officials are surprisingly apathetic and unhelpful. They refuse to allow doctors their democratic right to protest, and the only solution they have to offer is to advice hospitals not to allow more than two relatives at a time; to limit visiting hours ; and to employ more security guards !
Here are two simple things which hospitals can and should do on a priority basis.

Hospitals need to implement a Code Purple emergency response team. Any time any medical staff member feels that things seem to be getting out of hand - for example, when a patient is seriously ill , and the visitors are starting to get rude and restless, and a mob seems to be collecting, they should activate a Code Purple alarm. When this is sounded, everyone who is on duty in the hospital - nurses, clerks, peons, ward boys, security guards, and senior doctors - should drop what they are doing; call the local police ; and come instantly to help the junior doctor in his time of need. This is something which has been successfully deployed in a hospital in Pune, where it has successfully helped to prevent any incidents of abuse of the medical staff for many years. The hospital management should have a zero tolerance policy for staff abuse; and security needs to be beefed up.

It's also equally important that the hospital management insists that senior doctors must remain on duty 24/7. They can shield doctors from the wrath of the relatives. One of the reasons relatives get so angry when their patient is critically ill is because they can't see a senior doctor on the premises. They are understandably upset that the care of their patient is being delegated to a young inexperienced junior doctor , who is completely raw , and is not sure how to handle serious patients. When a junior doctor informs relatives that their patient has died; or is dying ; or needs to be transferred, they are very resentful that there is no senior doctor available to take care of their patient. This is when they start breaking things and beating up doctors. The presence of a senior doctor can change everything. An experienced dignified doctor with gravitas can talk to them, and calm them down. He has years of expertise, and knows how to deal with angry patients. He can establish a rapport, and his dignified presence will make a world of a difference, because the relatives can see that the senior medical A team is on the job, and is doing their best to save their patient. They will be much more understanding and forgiving. I find it quite remarkable that no has remarked on the fact that no senior doctor was available on the premises during all these episodes of medical violence. If there had been one, matters would never have come to such a pass. This is the least we can do for the sake of our junior doctors. It's very unfair to leave them exposed and vulnerable.